Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

Preliminary clinical application using 3D time-resolved imaging of contrast-enhanced MR angiography of contrast kinetics （3D-TRICKS）i

Objective：To introduce a new better contrast-enhanced MR angiographic metnod, named 3D time-resolved imaging of contrast kinetics （3D-TRICKS）. Methods： TRICKS is a high temporal resolution （2-6 s） MR angiographic technique using a short TR（4 ms） and TE（1.5 ms）, partial echo sampling, in which central part of k-space is updated more frequently than the peripheral part. TRICKS pre-contrast mask 3D images are firstly scanned, and then the bolus injecting of Gd-DTPA, 15-20 sequential 3D images are acquired. The reconstructed 3D images, subtraction of contrast 3D images with mask images, are conceptually similar to a catheter-based intra-arterial digital subtraction angiographic series （DSA）. Thirty patients underwent contrast-enhanced MR angiography using 3D-TRICKS. Results： Totally 12 vertebral arteries were well displayed on TRICKS, in which 7 were normal, 1 demonstrated bilateral vertebral artery stenosis, 4 had unilateral vertebral artery stenosis and 1 was accompanied with the same lateral carotid artery bifurcation stenosis. Four cases of bilateral renal arteries were normal, 1 transplanted kidney artery showed as normal and 1 transplanted kidney artery showed stenosis. 2 cerebral arteries were normal, 1 had sagittal sinus thrombosis and 1 displayed intracranial arteriovenous malformation. 3 pulmonary arteries were normal, 1 showed pulmonary artery thrombosis and 1 revealed pulmonary sequestration＇s abnormal feeding artery and draining vein. One left lower limb fibrolipoma showed feeding artery. One displayed radial-ulnar artery artificial fistula stenosis. One revealed left antebrachium hemangioma. Conclusion： TRICKS can clearly delineate most body vascular system and reveal most vascular abnormality. It possesses convenience and high successful rate, which make it the first choice of displaying most vascular abnormality.

Cervical aortic arch with aneurysm formation and an anomalous right subclavian artery and left vertebral artery:A case report

BACKGROUND A cervical aortic arch(CAA)refers to a high-riding aortic arch(AA)that often extends above the level of the clavicle.This condition is very rare,with an incidence of less than 1/10000.CASE SUMMARY A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo.The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission.A preoperative noncontrast chest computed tomography scan showed a high-riding,tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation.A further computed tomography angiography examination showed that the brachiocephalic trunk,left common carotid artery,left vertebral artery(LVA)(slender),and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA.The proximal end of the right subclavian artery(RSCA)was tortuous and dilated.The AA showed tumorlike local expansion,with a maximum diameter of approximately 4 cm.After consultation with the department of cardiac macrovascular surgery,the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department.The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass.No abnormality was found during the 2-mo follow-up after discharge.CONCLUSION A CAA is a rare congenital anomaly of vascular development.The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.

Dynamic Comparison of the Two Models to Enhance the Application Value of MRI in Cervical Cancer Case Classification

Objective:To explore the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)with Extended Tofts Linear(ETL)model and extended tofts(ET)model in pathological grading of cervical cancer.Method:Retrospective analysis was performed on 31 cases of patients admitted to Shaoxing People's Hospital from January 2016 to October 2019 who were pathologically confirmed to have cervical cancer.They underwent preoperative multistage pelvic DCE-MRI examination.Extended Tofts Linear and Extended Tofts hemodynamic model of cervical cancer were calculated separately,and the quantitative perfusion parameters including transport capacity constant(K^(trans)),the rate constant(K_(ep)),blood vessels,extracellular clearance volume fraction(V_(e)),blood vessels,and clearance volume fraction(V_(p)).According to the postoperative pathologic stage can be divided into low,medium and high differentiate cervical cancer group,the difference contrast of three groups of cervical cancer perfusion parameter were analyzed.The parameters with statistical significance were screened out,and the ROC curves for the differentiation of cervical cancer with different degrees were drawn.Result:The diagnostic efficacy of the quantitative parameters obtained by the two models in the pathological grading of cervical cancer was compared.The Ktrans values of the Exte Nded Tofts Linear model highly differentiated(0.518±0.180)min^(-1),poorly differentiated(1.032±0.408)min^(-1)and the Extended Tofts model highly differentiated(0.525±0.283)min^(-1),poorly differentiated(1.487±0.991)min^(-1)were significantly different between the highly differentiated and poorly differentiated groups(P<0.05).There were no significant differences in Kep,Ve and Vp between high and low differentiated cervical cancer groups(all P>0.05).There were no significant differences in Ktrans,Kep,Ve and Vp between the two models(all P>0.05).The AUC of Ktrans in the Exte Nded Tofts Linear model was greater than that of Ktrans in the Extended Tofts model for the identification of highly and poorly differentiated cervical cancers.Joint diagnosis:Logistic regression analysis was used to calculate the joint diagnostic probability values of Ktrans of the Extended Tofts Linear and Extended Tofts models,and the results showed that the AUC of the two models was greater than that of the single model.Conclusion:The Ktrans obtained by the Extended Tofts Linear model and the Extended Tofts DCE-MRI model had certain value for the pathological grading of high and low differentiated cervical cancer,and the overall efficacy of the former was better than the latter.Meanwhile,the differential value of the two models combined for the pathological grading of cervical cancer was better than that of the single model perfusion parameter,and the differential diagnosis sensitivity and specificity of the two models combined with Ktrans were the highest.

Enhancement maximum slope of increase of magnetic resonance angiography in patients with diabetes lower extremity arterial disease and its correlation with endothelial injury and oxidative stress

Objective:To study the enhancement maximum slope of increase of magnetic resonance angiography in patients with diabetes lower extremity arterial disease and its correlation with endothelial injury and oxidative stress.Methods: Patients with diabetes lower extremity arterial disease accepting 3D-CEMRA examination in our hospital between May 2013 and December 2015 were selected as the pathology group, and the enhancement maximum slope of increase was measured;healthy volunteers receiving physical examination in our hospital during the same period were selected as control group, and serum levels of endothelial oxidative stress injury-related molecules of two groups of subjects were determined.Results:The enhancement maximum slope of increase of the lesion-side anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery of pathology group were significantly lower than those of the unaffected-side;serum CyPA, ERK1, ERK2, Akt, JAK, HO-1 and CO content of pathology group were significantly higher than those of control group and negatively correlated with the enhancement maximum slope of increase of lower extremity while Prdx6, SOD, CAT, GSH-Px, eNOS and NO content were significantly lower than those of control group and positively correlated with the enhancement maximum slope of increase of lower extremity.Conclusion: The enhancement maximum slope of increase of magnetic resonance angiography significantly reduces in patients with diabetes lower extremity arterial disease and is closely related to oxidative stress-induced endothelial injury as well as eNOS/NO and HO-1/CO system function change.

无分叉颈动脉一例并文献复习

无分叉颈动脉是一种极其少见的颈动脉解剖变异,可能与胚胎期颈内动脉和颈外动脉的发育异常有关。颈部血管超声表现为颈动脉分叉水平未见明显膨大和分叉结构,DSA显示为颈动脉分叉水平无分叉结构,可见“残端样”改变,目前国内外研究报道不多。该研究报道1例无分叉颈动脉患者,中年男性,因头晕1个月就诊,既往有2型糖尿病、高血压病,住院后脑血管造影证实为左侧无分叉颈动脉伴右侧颈内动脉重度狭窄,经支架置入术及降压控糖治疗后症状缓解出院。结合该例临床资料及文献复习对无分叉颈动脉进行分析,旨在提高临床医师尤其是影像诊断医师对无分叉颈动脉的认识,避免误诊漏诊及相关并发症的发生。

多层螺旋CT仿真内窥镜在颈动脉狭窄中的诊断价值

目的:探讨多层螺旋CT仿真内窥镜技术(computed tomography virtual endoscopy,CTVE)在颈动脉狭窄中的诊断价值。方法:回顾性分析2021年1月—2023年3月期间汕头大学医学院第一附属医院收治的60例颈动脉狭窄患者的临床资料,其中男性49例,女性11例,年龄46~85(66±8)岁。所有患者均行颈部CT血管造影(computed tomography angiography,CTA)检查、颈部血管超声(cervical vascular ultrasound,CVUS)检查及数字减影血管造影(digital subtraction angiography,DSA)检查,其中CTA检查后进行CTVE成像处理。以DSA诊断结果为金标准,分析CTA联合CTVE及CVUS诊断颈动脉狭窄程度的一致性。结果:以DSA诊断结果为金标准,CTA联合CTVE及CVUS诊断颈动脉狭窄的Kappa值分别为0.764和0.756,均具有较好的一致性。CTA联合CTVE诊断不同程度颈动脉狭窄的Kappa值分别为0.702(轻度狭窄)、0.648(中度狭窄)、0.905(重度狭窄)、0.959(闭塞)。结论:CTVE在颈动脉狭窄中具有较好的诊断价值,尤其在对于颈动脉重度狭窄或闭塞的诊断中,其优势更加突出。

CT血管造影联合表观弥散系数全域直方图评估宫颈癌新辅助化疗效果的价值分析

目的:分析CT血管造影(CTA)联合表观弥散系数(ADC)全域直方图评估宫颈癌新辅助化疗效果的价值。方法:选取2021年7月至2022年10月喀什地区第一人民医院收治的40例术前新辅助化疗的宫颈癌患者,所有患者均在化疗前1 d和化疗结束后1 d行CTA、ADC全域直方图检查,比较CTA参数血容量(BV)、血流量(BF)、表面通透性(PS)以及平均通过时间(MTT),ADC全域直方图定量参数ADC值水平。结果:40例宫颈癌患者中新辅助化疗有效28例,无效12例。化疗后ADC值水平高于化疗前,BV、BF及PS水平低于化疗前,MTT水平高于化疗前,差异有统计学意义(t=9.558、8.283、7.852、7.302、18.480,P<0.05)。与新辅助化疗有效患者相比,新辅助化疗无效患者ADC值水平较低,BV、BF、PS水平较高,MTT水平较低(t=2.988、6.654、3.767、7.851、6.237,P<0.05)。受试者工作特征(ROC)曲线分析显示,两项联合预测宫颈癌新辅助化疗无效的ROC曲线下面积(AUC)高于CT血管造影、ADC全域直方图单项检测,AUC分别为0.905、0.839、0.729。结论:宫颈癌新辅助化疗后ADC值和MTT水平升高,BV、BF及PS水平降低,且化疗有效患者ADC值、MTT水平高于无效患者,BV、BF及PS水平低于无效患者,CTA联合ADC全域直方图对宫颈癌新辅助化疗无效的预测价值较高。

超声与DSA引导阻滞治疗神经根型颈椎病的临床比较

目的探讨超声与数字减影血管造影技术(digital subtraction angiography,DSA)引导阻滞治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床疗效。方法选择该院2020年2月~2022年2月收治的88例CSR患者为研究对象,均采用颈椎脊神经根阻滞治疗,根据不同穿刺引导方式分为两组:46例采用超声引导,设为超声组;42例采用DSA引导,设为DSA组。比较两组患者一次穿刺成功率、穿刺时间、手术时间,记录术后不良反应发生情况,比较术前、术后当天、术后1个月时的疼痛视觉模拟评分(visual analog scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)。结果超声组一次穿刺成功率高于对照组,穿刺时间、手术时间短于对照组(P<0.05);超声组不良反应总发生率显著低于对照组(P<0.05);两组术后当天、术后1个月的VAS、NDI均显著低于术前(P<0.05),但组间差异无统计学意义(P>0.05)。结论超声与DSA引导阻滞治疗CSR均能获得良好的近期疗效,但相较于DSA引导,超声引导穿刺效率更高、相关不良反应发生率更低。

颈部CTA二维及三维后处理指导颈椎病诊断及椎动脉狭窄程度评估的价值

目的:探讨颈部CT血管成像(CTA)二维及三维后处理对于颈椎病诊断及椎动脉狭窄程度评估的指导价值。方法:回顾分析2019年1月至2023年10月149例于本院行颈部CTA检查的颈椎疾病患者临床和影像学资料,通过CTA二维后处理分析患者颈椎病变情况,CTA三维后处理观察椎动脉变化,分析其对颈椎疾病分型、椎动脉狭窄程度及狭窄部位的诊断价值。结果:颈部CTA检查结果显示颈椎体骨质增生122例、颈椎曲度变直76例、曲度反弓状58例、椎间隙变窄66例、增生压迫神经根47例,椎动脉狭窄29例。颈部CTA检查颈椎病分型与颈椎病临床分型的总体符合率为84.56%,Kappa系数为0.763。29例患者接受椎动脉数字减影血管造影(DSA)检查,颈部CTA检查椎动脉狭窄程度与DSA检查的总体符合率为93.10%,Kappa系数为0.885;CTA检查与DSA诊断椎动狭窄部位比较,差异无统计学意义(P=0.798)。结论:颈部CTA二维及三维后处理对颈椎病分型有良好鉴别诊断价值,且对椎动脉狭窄程度及部位的诊断与DSA检查有较高的一致性。

不同的造影剂入路方式在头颈部CT血管造影中的应用

目的 通过经下肢静脉入路与常规上肢静脉入路团注造影剂行头颈部CT血管造影(CTA)检查,对所得2组图像进行对比观察及质量评价。方法 收集我院临床疑诊头颈部血管性病变并于我科行头颈部CTA联合检查的患者60例将其分为试验组(下肢静脉入路)和对照组(上肢静脉入路),每组30例。通过对从下肢静脉入路与从上肢静脉入路团注造影剂进行CTA检查所得图像进行比较、分析、评价。结果 试验组CT值低于对照组,平均CT值:试验组(310±10)Hu,对照组是(330±10)Hu。试验组30例患者图像头臂干、双侧颈总动脉起始部及双侧锁骨下动脉都较对照组显示良好(仅有2例目标血管内CT值偏低);对照组30例可见造影剂在邻近静脉残留,造成不同程度的伪影,干扰成像动脉的图像质量。结论 经下肢静脉入路的造影方案,获得了良好的符合影像诊断要求的CTA图像,所得图像目标血管管壁清晰,对比良好,无邻近伴行静脉内造影剂污染,影像信息真实可靠。

中青年与老年脑梗死患者临床特点及CVUS、CTA、MRA特征分析

目的探究中青年与老年脑梗死患者临床特点及颈部血管超声(CVUS)、CT血管造影(CTA)、磁共振血管造影(MRA)特征。方法回顾性分析103例脑梗死患者临床资料,所有患者均行CVUS、CTA及MRA检查,按照患者年龄分为中青年组(18~60岁)53例和老年组(>60岁)50例。比较两组患者一般资料、临床特征及影像学(CVUS、CTA、MRA)特征。结果中青年组年龄、总胆固醇(TC)、甘油三酯(TG)水平、糖尿病及高血脂占比均低于老年组,高学历、吸烟、饮酒、高血压占比均高于老年组(t分别=20.14、2.45、4.10,χ^(2)分别=5.00、7.59、12.62、4.50、6.79、3.90,P均<0.05);中青年组意识障碍、语言障碍、逐渐发作、活动时发病发生率均低于老年组,且发病时间短于老年组(χ^(2)分别=4.21、4.43、4.56、5.30,t=4.37,P均<0.05);CVUS及MRA显示,中青年组中未见明显异常占比高于老年组(χ^(2)分别=4.50、5.13,P均<0.05),CTA显示,中青年组中纤维核心混合斑块占比高于老年组(χ^(2)=5.83,P<0.05)。结论中青年脑梗死患者起病急,合并基础病较少,而老年脑梗死患者基础病较多,症状严重,中青年脑梗死患者血管病变程度低于老年患者。

颈部血管超声、动态心电图及CTA检查对冠状动脉病变程度的诊断价值

目的 分析颈部血管超声、动态心电图及CT血管造影(CTA)检查对冠状动脉病变程度的诊断价值。方法 选择本院自2020年1月—2022年7月接诊的146例冠心病患者为研究对象,根据冠状动脉造影检查结果,分为非重度组和重度组;两组患者均接受颈部血管超声、动态心电图及CTA检查,比较两组颈部血管超声检查指标[动脉硬化度(β)、颈动脉顺应性(AC)、弹性系数(EP)、颈动脉中膜厚度(IMT)]、动态心电图检查指标[正常N-N间期标准差(SDNN)、每5min N-N间期平均值的标准差(SDANN)、相邻N-N间期之差的均方根(RMSSD)],使用受试者工作特征(ROC)曲线分析颈部血管超声检查指标、动态心电图检查指标对重度冠状动脉病变的诊断效能,分析CTA检查对重度冠状动脉病变的诊断效能。结果 重度组β、EP、IMT均大于非重度组,AC小于非重度组,差异显著(P<0.05);重度组SDNN、SDANN、RMSSD均小于非重度组,差异显著(P<0.05);ROC曲线分析,SDNN、SDANN联合RMSSD诊断重度冠状动脉病变的AUC为0.930,β、EP、IMT联合AC诊断重度冠状动脉病变的AUC为0.908;以冠状动脉造影检查结果为金标准,CTA检查诊断重度冠状动脉病变的特异度为78.05%,敏感度为89.06%。结论 颈部血管超声、动态心电图及CTA检查结果均与冠状动脉病变程度有关,有助于重度冠状动脉病变的诊断,可为后续临床诊治提供重要依据。

头颈联合CT血管造影在头颈动脉狭窄中的应用

目的:探讨标准化头颈联合CTA检查在头颈动脉狭窄中的应用价值。方法:应用64层螺旋CT,对拟诊颅、颈动脉疾病的35例患者进行头颈联合CTA检查,均以九位法及自动旋转法来显示动脉的位置,对两种方法显示头颈动脉狭窄的能力进行对比分析。以常规DSA检查作为标准,评价CTA诊断头颈血管性病变的敏感性、特异性及准确性。结果:图像质量评分分别为2.81±0.32和2.83±0.36。九分法与自动旋转法对头颈动脉的显示差异有统计学意义(P<0.05)。头颈联合CTA总体诊断的敏感性、特异性及准确性分别为83.1%、99.4%、97.5%。结论:智能触发增强扫描技术结合头颈动脉九位法显示,不受个体差异影响,可以实施标准化头颈联合CTA检查,对头颈动脉狭窄的诊断及手术方案的制订具有很高的临床应用价值。

椎动脉造影与临床对照研究

对45例拟诊为推动脉型颈椎病患者进行了推动脉造影，其中30例行普通血管造影，15例行动脉法数字减影血管造影。对血管狭窄部位，采用计算机自动分析几何或密度法测定，头颈转位于血管同侧和对侧动态观察病变程度。结合临床发病、转颈试验和术中所见进行分析和讨论，提出动态观察血管病变和计算机自动分析狭窄程度在椎动脉型颈椎病的病因探讨和诊断治疗中具有重要的临床意义。

椎动脉三维CT血管成像的应用及临床意义

目的:探讨椎动脉型颈椎病患者椎动脉三维CT血管成像的影像学特征及其临床意义。方法:86例拟诊为椎动脉型颈椎病患者接受椎动脉三维CT血管成像(three-dimensionalCTangiographicimaging,3D-CTA)检查,重建椎动脉和颈椎骨及颅内椎-基底动脉,在CTA上观察椎动脉的外形、行经及与颈椎骨的关系。结果:86例患者的椎动脉CTA重建图像中血管先天畸形15例,血管硬化21例,骨质增生或纤维组织增生致血管局部受压38例,血管闭塞1例,血管瘤1例;椎动脉正常10例。先天畸形中发育异常9例,表现为整条血管纤细,直径小于2.5mm;走行异常6例。血管硬化表现为血管壁粗糙、不规则、粗细不均匀、钙化等。结论:CTA诊断椎动脉先天畸形和血管硬化有独到之处,椎动脉先天畸形和血管硬化是椎动脉型颈椎病发病的重要因素之一。

椎动脉动脉法数字减影血管造影研究

我院于1991～1996年对50例拟诊为椎动脉型颈椎病患者进行椎动脉动脉法数字减影血管造影研究，对于血管狭窄部位，采用计算机自动分析几何或密度法测定，在头颈转位子血管同侧和对侧动态观察病变程度，结合临床发病和转颈试验进行分析，提出动态观察血管病变和计算机自动分析狭窄程度在椎动脉型颈椎病的诊治中，具有重要的临床意义。

椎动脉型颈椎病的血管造影表现及其临床意义

目的探讨椎动脉型颈椎病(VCS)的血管造影表现及其临床意义。方法对76例VCS患者行椎动脉造影检查,观察椎动脉的走行、管径、是否存在狭窄及狭窄的部位等。结果76例患者中,67例有异常血管造影表现,包括:①椎动脉V2、V3段外压性狭窄50例;②椎动脉单纯硬化性狭窄10例;③椎动脉纡曲63例;④椎动脉走行异常8例;⑤椎动脉细小或缺如21例。结论VCS的血管造影表现非常复杂,椎动脉V2、V3段的受压、纡曲是诊断VCS的最主要依据。在此基础上,还应综合考虑患者椎-基底动脉系统的代偿机能,同时结合患者的病史、临床症状和体格检查,方能做出较为准确的诊断。

多层螺旋CTA与超声对比在颈部动脉疾病的诊断价值

目的通过对16层螺旋CT血管造影（CTangiography，CTA）和超声（ultrasonography，US）在颈部动脉常见病变的显示情况的对照研究，探讨CTA诊断颈部动脉病变的价值。方法对34例进行CTA、US及数字减影血管造影（digital subtraction angiography，DSA）检查的患者进行同颐性分析。以DSA结果为标准，评价CTA和US两种方法对颈部疾病的检出有无差异；根据其病变表现总结分类，了解CTA和US两种方法住颈部动脉分类病变检出的敏感度、准确度、特异度、阳性预测值及阴性预测值。结果在34例DSA检查的患者巾动脉粥样斑块106段，动脉狭窄41段，动脉闭塞11段，动脉发育纤细14段，动脉开口变异5段，病变血管共计177段。以DSA为标准，CTA对动脉粥样斑块、动脉狭窄、动脉闭塞、动脉发育纤细、动脉开口变异的显示分别为100、39、11、14、5段，共计169段；US的对上述病变的检出分别为94、33、9、13、1段，共计150段。CTA和US两种方法在颈动脉疾病的检出方面差异显著（P〈0．05）。以DSA为标准，CTA较US在颈部动脉疾病的检出上有更高的敏感性及特异性，CTA在颈部动脉分类病变检出敏感性、准确性及特异性均非常高（91．6％～100％），US在血管起始部病变的检测上明显不足。结论16层CTA较US能更全面检测颈部动脉病变。多层螺旋CTA可以作为无创性检测颈部动脉疾病的重要方法。

椎动脉磁共振血管成像对手法诊治椎动脉型颈椎病的研究

目的:探讨椎动脉磁共振血管成像(MRA)在椎动脉型颈椎病临床手法诊治中的重要作用,为椎动脉型颈椎病的临床诊治提供思路。方法:2007年5月至2010年12月,研究符合椎动脉型颈椎病诊断标准的患者(观察组,53例)和正常人(对照组,30例)的颈椎MRA中椎动脉走行及管径情况,其中观察组男19例,女34例;年龄26～72岁,平均(52.51±11.29)岁;对照组男10例,女20例;年龄25～70岁,平均(48.11±12.21)岁。比较两组受试者椎动脉走行及管径异常发生率的差异性,并结合X线、MRI、MRA资料对观察组的椎动脉走行及管径异常改变的因素及特点进行分析。结果:与对照组相比,观察组椎动脉走行及管径异常的发生率达81.13%(43/53),两者比较差异有统计学意义(P=0.000);且椎动脉走行及管径异常改变形式较复杂和多样化,其中以局部迂曲狭窄最为常见,累计占47.18%(25/53);局部迂曲狭窄因素以椎间关节错缝为主,占43.41%(23/53)。结论:椎动脉型颈椎病患者容易发生椎动脉走行及管径异常改变,而MRA可有效诊断椎动脉的异常改变。